Pregnancy outcomes in female patients exposed to cyclosporin‐based versus tacrolimus‐based immunosuppressive regimens after liver/kidney transplantation: A systematic review and meta‐analysis. (2nd January 2021) - Gong, Xiaojiao
Abstract: What is known and objective: Pregnancy after transplantation is a challenge owing to the high risk of adverse maternal and foetal outcomes, and immunosuppressants may further impact these outcomes. There are no head‐to‐head randomized controlled trials comparing influences of cyclosporin and tacrolimus on pregnancy outcomes. Thus, we systematically reviewed and meta‐analysed observational studies assessing the comparative influences of these two drugs on pregnancy outcomes in liver/kidney transplant recipients. Methods: Relevant studies comparing pregnancy outcomes with tacrolimus and cyclosporin head‐to‐head were searched in PubMed, EMBASE and Web of Science (from 1 January 2000 to 20 March 2020). The weighted mean difference and odds ratio (OR) were calculated to compare continuous and dichotomous variables, respectively, with 95% confidence intervals (CIs). Publication bias was estimated using funnel plots. The study quality was assessed according to the modified Newcastle–Ottawa scale. Results and discussion: Overall, 10 observational studies of low quality, including a total of 1080 post‐liver or kidney transplant pregnancies, were identified. Tacrolimus‐treated recipients experienced a lower risk of gestational hypertension (28.0%; OR: 1.74; 95% CI: 1.27–2.39; p < 0.01). Cyclosporin‐treated recipients showed a lower incidence of caesarean section (40.3%; OR: 0.62; 95% CI: 0.46–0.82; p < 0.01). Additionally, cyclosporin performed better in terms of the live birth rate (78.0%; OR: 1.38; 95% CI: 1.02–1.88; p = 0.04). No significant differences in the incidences of pre‐eclampsia, gestational diabetes, preterm delivery and birth weight were observed. What is new and conclusion: Tacrolimus performed better in patients with gestational hypertension, while cyclosporin was associated with a lower incidence of caesarean section and a higher incidence of live birth. The findings are based on relatively low‐quality evidence, but may provide a reference for clinicians in their clinical monitoring and obstetric care for post‐transplant pregnancies. Abstract : Tacrolimus performed better in patients with gestational hypertension, while cyclosporin was associated with a lower incidence of cesarean section and a higher incidence of live birth. These findings may provide a reference for clinicians in their clinical monitoring and obstetric care for post‐transplant pregnancies.